Patient Engagement Strategies in a Value-Based World...Patient Engagement Strategies in a...

Patient Engagement Strategies

in a Value-Based World

JANUARY 14, 2020

Jonathan G. Wiik, MHA MBA

Principal Healthcare Strategy

TransUnion Healthcare

[email protected]

720.221.2462

mailto:[email protected]

© 2020 Trans Union, LLC All Rights Reserved | 2

Learning Objectives

1 Examine the penetration of risk-based contracts and population management

2Closely examine patient as payer highlighting challenges in transparency,

consumerism, and affordability

3Understand the evolution of the revenue cycle and articulate the barriers and

opportunities in meeting the patient as payer

4Explore what is next for the US healthcare market and discuss some necessary

changes in the legislation, delivery and funding to meet the new patient payers

v

vv

Transition to Value and Risk


Regulatory and technology – Meaningful use, reimbursement, transparency, and others continue to increase

compliance pressure. Investments in technology will enable long term success, though many face up-front

investments at the same time as reduced reimbursement rates.

Transition to Value – Accountable Care Organizations and other delivery models are gaining momentum.

This increases the need for integration among hospitals, physicians, and patients to effectively manage patient

care and financial exposure among all parties. Consolidation of systems to ease access and save vendor cost

is also a trend.

Consumerism - Enhancing the customer experience begins with revenue cycle during scheduling and ends

with revenue cycle during account resolution and collections. As such, the revenue cycle will become an

increasingly key differentiator, and providing the seamless offerings of an integrated revenue cycle will be key to

appealing to the demands of modern health care consumers.

Competition from new entrants - Huge national system mega-mergers combined with retail competition,

along with non-traditional retail-based organizations are driving consumer choice and patient disengagement.

These however have had little direct impact to the healthcare consumer and affordability.

What are major market pressures for value-based care?

Source: Deloitte, https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/revenue-cycle-integration-insights.html

https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/revenue-cycle-integration-insights.html


Source: Kevin Holloran, Fitch ratings, HFMA Annual 2019

Changing Reimbursement Structures


Market is transitioning from FFS to VBC

Source: Becker’s 2017 RCM CIO conference; ACO Partner, Change Healthcare

v

vv

Market Challenges


Source: Kaufmann Hall, https://www.kaufmanhall.com/ideas-resources/thoughts-ken-kaufman/2018-do-list-healthcare-providers

Digital is future of consumer engagement:• 80% of U.S. adults own a smartphone

• Almost 75% of adults have used an on-demand online service

• Almost 75% of Millennials want to book appointments with mobile apps, would

prefer to see a doctor virtually, and look online for reviews before selecting a

doctor

Yet hospitals are still largely analog in a digital world:• Only 14% offer digital tools and information to enable consumer engagement

• Less than 25% offer a range of virtual/telehealth access points

• Only 40% provide messaging between patients and providers

Friction is rampant in healthcare• Paper, telephone and fax

• Appointment scheduling, communication with and among providers

• Wait times, difficult wayfinding

• Repetitive paperwork, confusing billing

Digitize engagement and care

https://www.kaufmanhall.com/ideas-resources/thoughts-ken-kaufman/2018-do-list-healthcare-providers

© 2020 Trans Union, LLC All Rights Reserved | 9Source: Kaufmann Hall, https://www.kaufmanhall.com/sites/default/files/documents/2019-

06/2019_state_of_consumerism_in_healthcare_kaufmanhall_0.pdf

Other than portals, providers are lagging in providing effective

digital tools to the healthcare consumer

18%

68%

87%92%

96%

82%

31%

12%6%

2%

Patient Portal Smartphone apps In-home monitoring Wearbable devices Voice-activated digital assistants(e.g. Alexa/Google)

Question: Indicate to what extent your organization offers the following digital tools to engage customers.

Not Available / Limited Widely Available / Best in Class I don't know

https://www.kaufmanhall.com/sites/default/files/documents/2019-06/2019_state_of_consumerism_in_healthcare_kaufmanhall_0.pdf


Antiquated, analog workflows cause misidentification and

disconnection - which can negatively impact patients

▪ Patient Safety – Diagnosis and treatment decisions may be made in the

absence of valuable information, putting patient safety at risk.

▪ Unnecessary Treatments – Patients may incur extra costs when clinicians

administer unnecessary or redundant tests due to incomplete or incorrectly

merged medical records.

▪ Wrong Prescription – Due to physicians not having access to complete

medical information, patients may be prescribed the wrong dosage or

medication.

▪ Poor Experience – Patient time may be wasted adhering to treatment plans

that will not yield optimal outcomes due to physicians or payers having

incomplete demographic information


Non-traditional retail models are defining the future healthcare

consumer

• Medical and clinical services have become commoditized

• Physician relationships are no longer sacred

• Consumer can self-navigate or assign their coordination of care:

– Work through a familiar relationship (Amazon, Travelocity, Chase Bank)

– These business don’t own the product or service – but will direct it

– Consumer chooses care based on what they want

• Quality is assumed

• Convenience and location are differentiators

• Service, ratings, word of mouth and social media drive brand

• Cost are flexible

– Coupons

– Off hours discounting

– Loyalty programs

Source: Beckers Health IT and RCM Conference 2018: Jonathan Manis, SVP/CIO Sutter Health


Source: Kaufmann Hall, https://www.kaufmanhall.com/sites/default/files/documents/2019-


Non-traditional retail entrants are top of mind with healthcare

executives

41% 45% 46%

33% 34%

26% 21%10%

6% 4%

UHG / Optum CVS Health / Aetna Amazon Google / Alphabet Apple

Question: Over the next five years, what degree of competivive threat do the following companies pose to hospitals and health systems?

Strong Threat Extreme Threat



Disruption from non-traditional entrants diminishes performance in

VBC contracts and can lead to service line disintegration

Source: Beckers Health IT and RCM Conference 2018: Jonathan Manis, SVP/CIO Sutter Health

v

vv

Opportunities to meet patient as payer


Today’s healthcare is episodic and mostly fee-for-service

Adapted from: HIMSS16: Patient Engagement Beyond Patient Portal; Tripathi and Katiyar;

Oliver Wyman


Large consumerism gaps exist for priorities versus capabilities

81%

61%

42%

28% 28% 27% 27%

11% 10%

4% 4% 3% 3% 3%

Improving customerservice

Offering a variety offacility based-access

points

Utilizing digital tools toengage consumers

Providing pricetransparency

Developing an outpatientpricing strategy

Offering a variety ofvirtual access points

Using consumer learningto guide strategy

High Priority High Capability

Source: Kaufmann Hall, https://www.kaufmanhall.com/sites/default/files/documents/2019-




Consumerism is driving demand for a retail healthcare experience


Oliver Wyman


Engagement in a value-based world has lots of inputs


Before you can perform against VBC goals, you have to know your

customers

Big Data: Healthcare

Worldwide healthcare data is expected to grow to

50x the current total to

25,000 petabytes

2012 500 petabytes =

10 billion four-drawer cabinets

2020 25,000 petabytes =

500 billion four-drawer cabinets


Data evolution

Roadmap for capturing, protecting and distributing data to multiple stakeholders


Unique patient demographics need to be tailored for care and

payment



Amazon knows their consumers better than anyone

– they collect and leverage behavioral data exhaustively

Hi, JonathanCustomer since 2013


Holistic understanding of individual risk attributes


Healthcare delivery paradigm needs to transition to a more holistic

model leveraging rich datasets, including SDOH

Traditional healthcare

delivery only impacts

10% of a patients’ well

being, resulting in high

ER utilization and IP

readmissions

Socio-demographic

attributes correlate

to risk elements

that can identify

barriers to care

Providing a reliable,

timely, and

actionable risk

dataset can drive

better decisions and

interventions

A targeted strategy

through identifying needs

in nutrition, transport,

housing, and others can

result in positive

outcomes for community,

provider, and bottom line


Rich datasets can enable stratification of patient risk for care and

payments

Identity Verification

▪ Verify identity and protect PHI

▪ Validate address and demographic information for engagement

Coverage and Risk

▪ Identify coverage and affordability

▪ Barriers to engagement and access to care

Insights and Actions

▪ Prioritize high need individuals

▪ Identify risk in care and paymentEngagement

Rapidly determine

Identity /

Contact

Coverage

and Risk

Access

and

Afford-

ability


Turning passive patients into active healthcare consumers

Source: Change Healthcare 2019 Pulse Survey http://images.discover.changehealthcare.com/Web/ChangeHealthcare/%7B0268088b-3e6a-4e6a-ada5-

116a6117b290%7D_Change_Healthcare_Industry_Pulse_2019_Digital.pdf -

49.3%

39.7%

34.0%

30.1%

27.8%

22.0%

19.6%

16.3%

16.3%

3.8%

2.4%

0% 10% 20% 30% 40% 50% 60%

Offers incentives for healthy behaviors

Promote healthcare literacy

Establish provider-patient partnership programs

Offer cost transparency tools

Leverage health risk assessment/managementapps

Implement gamification to motivate behavior

Offer and share provider scorecards

Offer health monitoring devices

Provide digital health assistants

Offer high deductible plans

Other

http://images.discover.changehealthcare.com/Web/ChangeHealthcare/%7B0268088b-3e6a-4e6a-ada5-116a6117b290%7D_Change_Healthcare_Industry_Pulse_2019_Digital.pdf


Once the data tells the story, ensure you can operationalize the outreach

with a omni-channel strategy – activate and engage your patients

Source: HFMA -https://www.hfma.org/courses/financial-benefits-of-setting-an-effective-patient-engagement-st.html

Pre-care Point of Care Post-care

• Care outreach • Tablet Check-in • Mobile discharge instructions

• Real-time scheduling • Timely Patient/Family

Notifications/Education

• Clinically-guided outreach and

education

• Pre-visit education • Discharge Prep • Targeted follow-up

• Mobile Check-in and payment • Assessments and Screenings • Medication & Post Care Adherence

• Appointment optimization • Secure Messaging

• Referral Management

https://www.hfma.org/courses/financial-benefits-of-setting-an-effective-patient-engagement-st.html


ROI for Data and Analytic Strategies for Value-based Care

Source: HFMA -https://www.hfma.org/courses/financial-benefits-of-setting-an-effective-patient-engagement-st.html

Platform Functionality Demonstrated ROI35% increase in care gap closure

30% quality improvement

2.5 new appointments / clinician / day

20-30% reduction in no show rate

8-10 min. saved per patient

80% reduction in paper

42% improvement in data quality

50% improvement in clean claim rate

30% increase in patient collections

86% collection in copay

4 day reduction in A/R days

22% quality improvement

9-14% increase in reimbursement

10% reduction in readmissions

30% increase in PCP follow up

Care outreach, Appointment Reminders, Pre-care prep

Mobile Check-in and payment

Assessments and Screenings

Care Plan and Referral Management

https://www.hfma.org/courses/financial-benefits-of-setting-an-effective-patient-engagement-st.html


Optimize patient engagement for care and payment

Verify patient demographics to ensure connectivity for active

engagement in a tailored strategy

Educate patients about the care, costs and coverage options

Establish coverage mechanisms in advance of care and collect

patient amounts PRIOR to service

Actively segment bad debt into high yield and high risk (SDOH)

accounts

Clean up uncompensated care by locating unknown insurance and

closely monitor payments from patient and payment


Data-driven decisions for patient-centered care

Physicians

HospitalsPayers

THANK YOU!

Jonathan G. Wiik, MHA, MBAPrincipal, Healthcare Strategy

TransUnion Healthcare

[email protected]

QUESTIONS

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